The Efficacy of Different Chemotherapy Regimens for Advanced Biliary Tract Cancer: A Systematic Review and Network Meta-Analysis

Li, Yan; Zhou, Yaoyao; Hong, Yonglan; He, Meizhi; Wei, Shuyi; Yang, Chen; Zheng, Deyou; Liu, Feiye

doi:10.3389/fonc.2019.00441

Cited by 7 publications

(10 citation statements)

References 50 publications

(53 reference statements)

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“…Meanwhile, we also found that GEMOX+erlotinib was better than the protocol fluorouracil+folic acid in OS, PFS, and ORR. Both previous NMAs also suggested that protocol gemcitabine was superior to protocol fluorouracil ( 38 , 39 ). Cediranib combination chemotherapy in this NMA also has preferable ORR and tolerance.…”

Section: Discussionmentioning

confidence: 93%

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Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis

Jiang

Zeng

et al. 2021

Front. Oncol.

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BackgroundAt present, chemotherapy is still the primary treatment for advanced biliary tract carcinoma, but it is challenging to balance the efficacy and side effects. Network meta-analysis (NMA) is a better way to identify the protocol, and the advantage is that it can be combined with direct and indirect evidence to judge the best treatment regimens. Therefore, we conducted NMA on the searched randomized controlled trials (RCTs).MethodsNMA was conducted regarding the searched RCTs by comparing progression-free survival (PFS), overall survival (OS), objective remission rates (ORRs), and adverse events (AEs) of different chemotherapy protocols.ResultsWe screened 24 studies that met the inclusion criteria for further analysis. Compared with other regimens, the best supportive care (BSC) or FUFA protocol has a worse OS. Folfox4, GEMOX+erlotinib, and C+GEMOX can improve patients’ PFS compared with BSC. Patients receiving GP+cediranib protocol have higher ORRs. There was reduced neutropenia grade ≥3 when adopting GP+cediranib, GS, C+GEMOX, RAM+GP, and MER+GP than when using FUFA protocol. The probability of vomiting of XELOX is lower than that of GEM+XELOX. There is a lower diarrhea incidence of XELOX than that of GEMOX+erlotinib. The results of cluster grade analysis illustrated that GEMOX+erlotinib owned a higher ORR and a higher surface under the cumulative ranking (SUCRA) of neutropenia and vomiting but also had a lower SUCRA of diarrhea and fatigue. Meanwhile, both GEMOX and C+GEMOX have a better ORR and a higher AE SUCRA.ConclusionThe NMA demonstrated that chemotherapy combined with targeted therapy has better efficacy and lower incidence of AEs than chemotherapy alone.

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Section: Discussionmentioning

confidence: 93%

“…However, there is still a lack of evidence-based evidence on how doctors should choose many protocols. Li et al ( 39 ) also compared the efficacy of chemotherapy protocols in his recent NMA on advanced BTC but did not compare AEs.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis

Jiang

Zeng

et al. 2021

Front. Oncol.

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“…This finding has also been reported in first-line chemotherapy. 13 , 30 During the follow-up, we found that the patients with GS regimen had higher compliance, which may be related to the simplicity of treatment, lower adverse reactions and an intrinsic higher efficacy of S-1, so these patients could receive more cycles of treatment. The differences could not be observed may be owing to low numerosity.…”

Section: Discussionmentioning

confidence: 93%

Efficacy Analysis of Adjuvant Chemotherapy with Gemcitabine Plus Platinum or S-1 in Biliary Tract Carcinoma: A Multi-Center Retrospective Study

Gao¹,

Tian²,

Li³

et al. 2021

CMAR

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Purpose Biliary tract cancers (BTCs) have a poor overall prognosis, as patients who underwent curative surgery frequently experience disease recurrence. At present, there is a paucity of well-documented adjuvant chemotherapy regimen. This study aimed to assess whether gemcitabine plus platinum or S-1 adjuvant chemotherapy have different impact on relapse-free survival (RFS). Patients and Methods We selected patients undergoing radical biliary tract cancer surgery, pathologically confirmed adenocarcinoma and received gemcitabine plus platinum (cisplatin or oxaliplatin) or S-1 adjuvant chemotherapy from September 2013 to May 2020. The primary study endpoint was RFS. The secondary endpoint was safety. Results Overall 136 patients were enrolled. The median follow-up was 32.3 months and the median RFS was 17.0 months (95% CI 8.9–25.1). The median RFS was 14.1 months (95% CI 6.7–21.5) in gemcitabine plus platinum group and 33.0 months (95% CI 9.3–56.7) in gemcitabine plus S-1 (GS) group, a non-significant difference both in univariate (P=0.092) and in multivariate analysis (P=0.058). Lymph node status (N- vs N+: HR=0.477, 95% CI 0.285–0.799; P=0.005) and chemotherapy cycles (<6 vs 6–8: HR=1.828, 95% CI 1.117–2.993; P=0.016) were independent impact factors for RFS. GS group had lower incidence of adverse reactions. Conclusion Compared with gemcitabine plus platinum, GS regimen has a tendency to obtain longer RFS (although there is no statistically significant difference) and less toxic. GS regimen has the potential to be investigated as a standard regimen for adjuvant chemotherapy.

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“…Observation 3 G-based(246) Observation(238) 484 patients Julien Edeline, 2022 [ 28 ] NA EUROPEAN JOURNAL OF CANCER 2 Meta-analysis RCTs G-based vs. Observation 2 G-based(212) Observation(207) 419 patients Abdel-Rahman O, 2018 [ 29 ] 2017/06 COCHRANE DATABASE OF SYSTEMATIC REVIEWS 7 Meta-analysis RCTs G + S-1 vs. S-1 2 G + S-1(76) S-1(75) 151 patients Yan Li,2019 [ 30 ] 2018/10/06 FRONTIERS IN ONCOLOGY 25 Network Meta-analysis Restrospective; RCTs Folfox-4 vs. Observation NA Folfox-4(NA) Observation(NA) NA XP vs. GP NA XP(NA) GP(NA) NA G + S-1 vs. GC NA GS(NA) GC(NA) NA Jie Ying, 2019 [ 31 ] 2018/04 CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY 32 Network Meta-analysis Restrospective; RCTs G-based CHT vs. single CHT(mainly FU alone) …”

Section: Resultsmentioning

confidence: 99%

Chemotherapy and targeted therapy for advanced biliary tract cancers: an umbrella review

et al. 2023

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Background Malignant tumors of the biliary system are characterized by a high degree of malignancy and strong invasiveness, and they are usually diagnosed at late stages with poor prognosis. For patients with advanced biliary tract cancer, chemotherapy and targeted therapy are two of the options available to improve prognosis and delay tumor progression. This study aimed to comprehensively evaluate the safety and effectiveness of various chemotherapy schemes for the treatment of advanced biliary tract cancer in published systematic reviews and meta-analyses (SRoMAs). Methods An umbrella review method was adopted, which aims to summarize the existing evidence from multiple studies around a research topic. SRoMAs up to April 9, 2022, were identified using PubMed, Web of Science, the Cochrane database, and manual screening. Eligible studies were screened according to inclusion and exclusion criteria. This study had been registered at PROSPERO (CRD42022324548). For each eligible study, we extracted the data of general characteristics and the main findings. The methodological quality of the included studies were assessed by the AMSTAR2 scale, and the quality of evidence was evaluated by the GRADE tools. Results A total of 1833 articles were searched; 14 unique articles with 94 outcomes were identified by eligibility criteria. The incidence of skin rash (RR = 18.11, 95% CI 5.13–63.91, GRADE: Moderate) and diarrhea (RR = 2.48, 95% CI 1.2–5.10, GRADE: Moderate) was higher in patients receiving gemcitabine-based chemotherapy plus targeted therapy than in patients receiving gemcitabine monotherapy. The number of patients receiving gemcitabine-based chemotherapy who developed leukopenia (OR = 7.17, 95% CI 1.43–36.08, GRADE: Moderate), anemia (OR = 7.04, 95% CI 2.59–19.12, GRADE: High), thrombocytopenia (RR = 2.45, 95% CI 1.39–4.32, GRADE: Moderate), and neutropenia (RR = 3.30, 95% CI 1.04–10.50, GRADE: Moderate) was significantly higher than that of patients who received gemcitabine-free regimens. In addition, patients receiving S-1 monotherapy had significantly better ORR (RR = 2.46, 95% CI 1.27–4.57, GRADE: Moderate) than patients receiving S-1 + gemcitabine. Patients receiving fluoropyrimidine-based chemotherapy had longer OS (HR = 0.83, 95% CI 0.7–0.99, GRADE: Moderate), higher DCR (0R = 5.18, 95% CI 3.3–10.23, GRADE: Moderate), and higher ORR (0R = 3.24, 95% CI 1.18–8.92, GRADE: Moderate) compared with patients who received 5-FU/LV monotherapy or supportive therapy. Surprisingly, we found evidence that gemcitabine-based chemotherapy did not improve postoperative patients’ OS (HR = 0.91, 95% CI 0.74–1.12, GRADE: Moderate) when compared with best supportive care. Conclusions This study comprehensively evaluated the safety and efficacy of chemotherapy or targeted therapy regimens for advanced biliary tract cancer and found 11 outcomes with “Moderate” or “High” levels; however, most of the outcomes were still at “low” or “very low” levels. More randomized controlled studies are needed in the future to further summarize high levels of evidence.

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The Efficacy of Different Chemotherapy Regimens for Advanced Biliary Tract Cancer: A Systematic Review and Network Meta-Analysis

Cited by 7 publications

References 50 publications

Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis

Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis

Efficacy Analysis of Adjuvant Chemotherapy with Gemcitabine Plus Platinum or S-1 in Biliary Tract Carcinoma: A Multi-Center Retrospective Study

Chemotherapy and targeted therapy for advanced biliary tract cancers: an umbrella review

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